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Just Say No to the TPP: A Democratic Setback for American and Asian Public Health Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

ABSTRACT: (TPP) policy and the severe threats to public health that it implies for 12 Pacific Rim populations from the Americas and Asia (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States, and Vietnam). With careful and analytic precision the authors convincingly unearth many aspects of this piece of legislation that undermine the public health achievements of most countries involved in the TTP. Our comments complement their policy analysis with the aim of providing a positive heuristic tool to assist in the understanding of the TPP, and other upcoming treaties like the even more encompassing Transatlantic Trade and Investment Partnership (TTIP), and in so doing motivate the public health community to oppose the implementation of the relevant provisions of the agreements. The aims of this commentary on the study of Labonté et al are to show that an understanding of the health effects of the TPP is incomplete without a political analysis of policy formation, and that realist methods can be useful to uncover the mechanisms underlying TPP's political and policy processes.

SUBMITTER: Muntaner C

PROVIDER: S-EPMC5505113 | biostudies-other | 2016 Nov

REPOSITORIES: biostudies-other

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Project description:Objective: The aim of this study was to describe current measurement of health disparities for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations and subgroups across U.S. states. Methods: State department of health websites were searched for publicly available online reports and interactive databases denoted as state health or minority health assessments. Sources were examined to determine whether health metrics stratified by any racial/ethnic groups included the AANHPI aggregate population or subgroups. The number and frequency of AANHPI population designations were tabulated, as were the proportion of states that included AANHPIs in stratified metrics in four domains across the life span and the median number of metrics (1) stratified by any racial/ethnic group and (2) including AANHPI populations. A Pearson correlation coefficient assessed the association between the proportion of AANHPIs in state populations and the proportion of state metrics that included AANHPIs in the stratification. Results: States used 17 AANHPI population descriptors. Of 49 states stratifying health metrics by race/ethnicity, 34 included AANHPI populations and 2 included disaggregated AANHPI subgroups in ≥1 metric. The proportion of states that included AANHPI populations in stratification ranged from 57% for maternal–infant health to 69% for adult health, and by metric groups within domains, the proportion ranged from 14% for maternal mortality to 100% for marital or head of household status. The median number of metrics reported for AANHPI populations was lower than the median number reported for other racial/ethnic groups in adult, maternal–infant, and child and adolescent health domains. The proportion of state metrics that included AANHPIs in racial/ethnic stratification was not correlated with the proportion of AANHPIs in state populations (r=0.30). Conclusions and Implications for Health Equity: AANHPIs were substantially underrepresented in state health equity data, with rare subgroup disaggregation. Reducing disparities and inequities affecting AANHPI health in the United States requires improved and equitable data.

Project description:BackgroundThe Breast Cancer Risk Assessment Tool (BCRAT) of the National Cancer Institute is widely used for estimating absolute risk of invasive breast cancer. However, the absolute risk estimates for Asian and Pacific Islander American (APA) women are based on data from white women. We developed a model for projecting absolute invasive breast cancer risk in APA women and compared its projections to those from BCRAT.MethodsData from 589 women with breast cancer (case patients) and 952 women without breast cancer (control subjects) in the Asian American Breast Cancer Study were used to compute relative and attributable risks based on the age at menarche, number of affected mothers, sisters, and daughters, and number of previous benign biopsies. Absolute risks were obtained by combining this information with ethnicity-specific data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and with US ethnicity-specific mortality data to create the Asian American Breast Cancer Study model (AABCS model). Independent data from APA women in the Women's Health Initiative (WHI) were used to check the calibration and discriminatory accuracy of the AABCS model.ResultsThe AABCS model estimated absolute risk separately for Chinese, Japanese, Filipino, Hawaiian, Other Pacific Islander, and Other Asian women. Relative and attributable risks for APA women were comparable to those in BCRAT, but the AABCS model usually estimated lower-risk projections than BCRAT in Chinese and Filipino, but not in Hawaiian women, and not in every age and ethnic subgroup. The AABCS model underestimated absolute risk by 17% (95% confidence interval = 1% to 38%) in independent data from WHI, but APA women in the WHI had incidence rates approximately 18% higher than those estimated from the SEER program.ConclusionsThe AABCS model was calibrated to ethnicity-specific incidence rates from the SEER program for projecting absolute invasive breast cancer risk and is preferable to BCRAT for counseling APA women.

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Just Say No to the TPP: A Democratic Setback for American and Asian Public Health Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

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